Provider Demographics
NPI:1831466952
Name:CRAIG N FIEVET, DMD, PC
Entity Type:Organization
Organization Name:CRAIG N FIEVET, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:N
Authorized Official - Last Name:FIEVET
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-979-3760
Mailing Address - Street 1:1003 OAK RD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1826
Mailing Address - Country:US
Mailing Address - Phone:770-979-3760
Mailing Address - Fax:
Practice Address - Street 1:1003 OAK RD SW
Practice Address - Street 2:SUITE A
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1826
Practice Address - Country:US
Practice Address - Phone:770-979-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008762261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental